Bacterial Vaginosis

Question 1

What is the most frequent cause of vaginal discharge among women of child bearing age?

Answer 1

bacterial vaginosis

Question 2

Give 5 types of bacteria that cause bacterial vaginosis:

Answer 2

1) Gardnerella vaginalis
2) Mycoplasmas
3) Mobiluncus species
4) Anaerobes
5) Provotella species

Question 3

True or false: bacterial vaginosis is a sexually transmitted infection

Answer 3

false (however, it can increase the risk of women developing sexually transmitted infections)

Question 4

True or false: bacterial vaginosis increases the risk of acquisition and transmission of HIV

Answer 4

True

Question 5

Describe the pathogenesis of bacterial vaginosis:

Answer 5

1) Lactobacilli are the main component of healthy vaginal flora and they produce lactic acid that keeps the vaginal pH low (under 4.5)
2) this acidic environment prevents other bacteria from growing
3) when there are reduced numbers of lactobacilli in the vagina, the pH rises, becoming more alkaline, enabling infective anaerobic bacteria to multiply

Question 6

What is the main component of healthy vaginal flora?

Answer 6

Lactobacilli

Question 7

Name 3 infections that bacterial vaginosis commonly occurs alongside:

Answer 7

1) candidiasis
2) chlamydia
3) gonorrhoea

Question 8

Name 5 risk factors for bacterial vaginosis:

Answer 8

1) multiple sexual partners
2) copper coil
3) smoking
4) recent antibiotics
5) excessive vaginal cleaning

Question 9

Give 3 examples of excessive vaginal cleaning that can cause bacterial vaginosis:

Answer 9

1) vaginal washes
2) harsh cleaning products
3) vaginal douching

Question 10

What is the key clinical and diagnostic finding for bacterial vaginosis?

Answer 10

fishy-smelling watery grey or white vaginal discharge

Question 11

True or false: half of women with bacterial vaginosis are asymptomatic

Answer 11

True

Question 12

What makes the vaginal discharge white and frothy in bacterial vaginsosi?

Answer 12

volatile amine production of the infective bacteria

Question 13

What examination can be used to better examine discharge in bacterial vaginosis?

Answer 13

speculum

Question 14

Give two investigations used to diagnose bacterial vaginosis:

Answer 14

1) vaginal pH test
2) vaginal swab for Gram stained microscopy

Question 15

What is the normal pH of the vagina?

Answer 15

3.5-4.5

Question 16

What is the pH of the vagina in bacterial vaginosis?

Answer 16

> 4.5

Question 17

What is a key finding found upon microscopy in bacterial vaginosis?

Answer 17

clue cells

Question 18

What are clue cells?

Answer 18

epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis

Question 19

What antibiotic is used to treat bacterial vaginosis?

Answer 19

Metronidazole

Question 20

Give two ways that metronidazole can be given in bacterial vaginosis:

Answer 20

1) orally
2) vaginal gel

Question 21

What is the less-effective alternative to Metronidazole when treating bacterial vaginosis?

Answer 21

Clindamycin

Question 22

What should patients be advised to avoid when taking Metronidazole?

Answer 22

alcohol

Question 23

Why should patients avoid alcohol when taking Metronidazole?

Answer 23

it can cause a disulfiram-like reaction (nausea, vomiting, flushing and in severe cases, symptoms of shock and angioedema)

Question 24

Give 6 complications of bacterial vaginosis in pregnant women:

Answer 24

1) miscarriage
2) preterm delivery
3) post-partum endometritis
4) premature rupture of membranes
5) low birth weight
6) chorioamnionitis